Telepsychiatry gigs in 2023

[Stagg737]

I have 1 day virtual outpatient at the VA right now as a resident and Columbia's are required for every new patient and then annually thereafter, but that's true for in person too. The only annoying thing for me specific to telehealth is the virtual video visit header requiring verification of their physical location and emergency contact information for every note should they get disconnected and there's a possible emergency but it's like an extra minute.

Does your clinic still do a PHQ-2 for every encounter? When I was at the VA every patient had to do one at check-in and if it was positive then we'd have to do a Columbia during the appointment and potentially a CSRE. I found a bit of a work-around with the CSRE for patients with chronic SI, but was behind more days than not due to having to complete a new comprehensive on patients with an exacerbation or new SI. I'm sure you can imagine how often a PHQ-2 would trigger a Columbia at the VA though and I had to do Columbias on patients far more often than annually, which is what I'm mostly curious about now.

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[EastSide]

Yeah 100% virtual at the VA is amazing which is why I found the poster's comments so weird. But yes, indeed, these are coveted jobs and highly competitive relative to in person or partially in person positions. That doesn't mean the poster can't get one of course, they may just have to apply to a few.

Have you heard of any VA in-house psychiatrist supplementing their income with virtual? If so, any idea what the ballpark is for additional income potential?
Thanks!
I’m in training now but thinking of VA, but the lower salary deterred me away.

 

[milesed]

What are your plans for when (or if) the Ryan Haight Act starts to be enforced again?

 

[littlefred]

What are your plans for when (or if) the Ryan Haight Act starts to be enforced again?

That won't ever get enforced again. Don't sweat it.

 

[ObsequiousAplomb]

That won't ever get enforced again. Don't sweat it.

Agreed. In this political climate, they're either never enforcing it again or they're going to have to set up the telemedicine rules they originally said they would have to. At this point I doubt private equity will stop paying off the politicians long enough for this to ever be stopped.

 

[littlefred]

Agreed. In this political climate, they're either never enforcing it again or they're going to have to set up the telemedicine rules they originally said they would have to. At this point I doubt private equity will stop paying off the politicians long enough for this to ever be stopped.

Right, and remember it was created because of a person that died from an overdose without being seen physically by the prescribing doc.
Now we have an overdose epidemic and ironically telemedicine might be actually saving some lives (tele bupe for example).

 

[Jules A]

I have 1 day virtual outpatient at the VA right now as a resident and Columbia's are required for every new patient and then annually thereafter, but that's true for in person too. The only annoying thing for me specific to telehealth is the virtual video visit header requiring verification of their physical location and emergency contact information for every note should they get disconnected and there's a possible emergency but it's like an extra minute.

This ^^ and the patient should actually be doing the e911 entry not the doc but it rarely happens.

 

[soundnin]

Does your clinic still do a PHQ-2 for every encounter? When I was at the VA every patient had to do one at check-in and if it was positive then we'd have to do a Columbia during the appointment and potentially a CSRE. I found a bit of a work-around with the CSRE for patients with chronic SI, but was behind more days than not due to having to complete a new comprehensive on patients with an exacerbation or new SI. I'm sure you can imagine how often a PHQ-2 would trigger a Columbia at the VA though and I had to do Columbias on patients far more often than annually, which is what I'm mostly curious about now.

It's not required to do PHQ-2s for every encounter but we use BHL Touch now and the PHQ-9 is sent to patients prior to appointments (along with whatever else is relevant). I'm not sure how many outpatient psychiatrists actually do this. Regardless, if the patient fills it out and they answer yes on question 9, I just have to address it specifically in my note somewhere.

I've found Columbias to be overused much more often in the inpatient setting than outpatient at the VA, most egregious being on the C/L service when non-psych staff were doing it on every interaction with a patient and then consulting or paging psych about it...

 

[comp1]

Concur, Ryan Haight will never be enforced again. In terms of the CSRE, yes it's annoying. However, if you already did an intake or are otherwise familiar with the patient, it should add absolutely no more than 5 minutes to any patient encounter and possibly as little as 3 once you get familair with the intricacies of the form. Concur that mandatory Columbias triggering an inappropriate CSRE are much more of an issue on medical floor inpatient services and ED than outpatient as it's unlikely the C/L service is intimately familiar with the patient, but it does happen for the frequent flyers. In terms of supplementing income, I'm not sure what the poster above means. VA physicians generally can't earn overtime through the VA. It has to do with Title 38. A well run VA call pool with manage this through offering VA attendings in lieu of days off, but that won't help someone looking for actual income. For that, you'd have to go outside the VA and fortunately the VA has no limits on outside employment as long as it is outside your tour of duty.